Chronic arterial insufficiency Flashcards
What proportion of patients with PVD are symptomatic?
25%
Name the 2 conditions associated with chronic lower limb ischaemia
Intermittent claudication
Critical limb ischaemia
What is the underlying cause of intermittent claudication and critical limb ischaemia?
Atherosclerosis
Name 5 risk factors for peripheral vascular disease
Smoking (9x) Hypertension (3x) Diabetes mellitus (4x) Hyperlipidaemia Age FHx CAD or CVD
Define intermittent claudication
Muscle pain of the lower limb on walking exercise, that is relieved by a short period of rest. Onset of symptoms >2 weeks.
Where does intermittent claudication most commonly manifest?
Calf muscles
Outline the prognosis of intermittent claudication
1/3 improve
1/3 remain stable
1/3 deteriorate
4% require intervention
2% result in amputation
Name 3 differentials for intermittent claudication
Spinal stenosis OA (esp hip) Sciatica Musculoligamentous strain Popliteal artery entrapment (rare)
Name the vessels affected in intermittent claudication
Superficial femoral artery (80%)
Aorto-iliac arteries (15%)
Calf arteries (5%)
What are the 3 presentations of intermittent claudication?
Calf claudication (80%)
Calf, thigh, and buttock claudication (18%)
Leriche’s syndrome (2%)
What is Leriche’s syndrome?
Aorto-Iliac occlusion disease.
A chronic lower limb ischaemia characterised by:
- Bilateral buttock claudication
- Erectile dysfunction
- Absent femoral pulses
Describe the illness course of intermittent claudication
80% show no progression over 5 years.
After 5yr, 11% who smoke undergo amputation.
What is the impact of smoking on intermittent claudication outcome?
After 5 years, 11% of smokers with claudication will undergo amputation. Compared to 0% who stop smoking.
Smoking also increases mortality.
What is the impact of diabetes on intermittent claudication outcome?
Amputation rate over 5 years in 4x that of non-diabetics.
Increased risk of bypass failure.
What investigations should be ordered in intermittent claudication?
FBC BM Serum lipids and cholesterol Ankle/brachial pressure index Exercise test
Duplex ultrasound: to all people for whom revascularisation is being considered.
What is the role of full blood count in intermittent claudication management?
Assess the presence of anaemia, as it can aggravate vascular disease.
What results of Ankle/brachial pressure index indicate normality and arterial disease?
Normal >1.1
Arterial disease <0.9